Exocrine Pancreatic Insufficiency (EPI)

  • Medical Author:
    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

  • Medical Editor: Bhupinder S. Anand, MBBS, MD, DPHIL (OXON)
    Bhupinder S. Anand, MBBS, MD, DPHIL (OXON)

    Bhupinder S. Anand, MBBS, MD, DPHIL (OXON)

    Dr. Anand received MBBS degree from Medical College Amritsar, University of Punjab. He completed his Internal Medicine residency at the Postgraduate Institute of medical Education and Research, Chandigarh, India. He was trained in the field of Gastroenterology and obtained the DPhil degree. Dr. Anand is board-certified in Internal Medicine and Gastroenterology.

What Causes Intestinal Gas?

Intestinal gas (farting or flatulence) is produced by bacteria when they digest foods, primarily sugars and nondigestible polysaccharides, that have not been digested during passage through the small intestine. Examples of these foods include:

  • Lactose (the sugar in milk)
  • High fructose corn syrup
  • Rice
  • Wheat, oats, potatoes
  • Purified grains (refined flours, etc.)
  • Fruits
  • Vegetables

Exocrine pancreatic insufficiency (EPI) definition and facts

  • Exocrine pancreatic insufficiency (EPI) is a condition in which a person's pancreas is unable to produce and/or secrete adequate amounts of enzymes into the gastrointestinal track resulting in an inability to digest and thus absorb some fats, vitamins and minerals from food.
  • Symptoms of exocrine pancreatic insufficiency may include:
  • Causes of exocrine pancreatic insufficiency may be either pancreatic or non-pancreatic, for example, a pancreatic cause could be chronic pancreatitis while a non-pancreatic cause could be celiac disease.
  • Exocrine pancreatic insufficiency may be difficult to diagnose since it symptoms mimic other problems; however, the patient's history, physical exam and blood tests to check on the levels of vitamins, pancreatic enzymes along with studies on fat absorption (fecal test), and results from CT, MRI and/or ultrasound studies of the pancreas can provide the diagnosis of exocrine pancreatic insufficiency.
  • Treatments of exocrine pancreatic insufficiency may include pancreatic enzyme replacement therapy (PERT), dietary changes and vitamin supplements. PERT treatment plans are individualized according to the needs of the patient and the severity of EPI.
  • Individuals can help manage exocrine pancreatic insufficiency at home by following their doctor's instructions for treating the underlying causes of exocrine pancreatic insufficiency-additionally, lifestyle modifications such as avoiding fatty foods, reducing or eliminating alcohol intake and eating a balanced diet with vitamin supplementation and/or carefully timing PERT therapy with meals according to your doctor's instructions can be very helpful in reducing symptoms.
  • In some individuals, exocrine pancreatic insufficiency can be prevented or stopped from progressing if the underlying cause is treated; however, other causes (for example, genetic causes such as presence of the cystic fibrosis gene) are not preventable.
  • The prognosis for an individual with exocrine pancreatic insufficiency depends on the underlying cause. Some individuals who have underlying causes that are treatable may have a good prognosis, but others may have only a fair to poor prognosis if they develop complete pancreatic insufficiency and do not respond well to enzyme treatment therapies or refuse to modify their diets.
Medically Reviewed by a Doctor on 7/21/2016

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